We have previously reported on a predictive model for deficiency-excess pattern diagnosis that was unable to predict the medium pattern. In this study, we aimed to develop predictive models for deficiency, medium,and excess pattern diagnosis, and to confirm whether cutoff values for diagnosis differed between the clinics. We collected data from patients' first visit to one of six Kampo clinics in Japan from January 2012 to February 2015. Exclusion criteria included unwillingness to participate in the study, missing data, duplicate data, under 20 years old, 20 or less subjective symptoms, and irrelevant patterns. In total, 1,068 participants were included. Participants were surveyed using a 153-item questionnaire. We constructed a predictive model for deficiency, medium, and excess pattern diagnosis using a random forest algorithm from training data, and extracted the most important items. We calculated predictive values for each participant by applying their data to the predictive model, and created receiver operating characteristic (ROC) curves with excess-medium and medium-deficiency patterns. Furthermore, we calculated the cutoff value for these patterns in each clinic using ROC curves, and compared them. Body mass index and blood pressure were the most important items. In all clinics, the cutoff values for diagnosis of excess-medium and medium-deficiency patterns was > 0.5 and < 0.5, respectively. We created a predictive model for deficiency, medium, and excess pattern diagnosis from the data of six Kampo clinics in Japan. The cutoff values for these patterns fell within a narrow range in the six clinics.

It is written about daiobotampito in ‘Jin Gui Yao Lue' that the patients who should be treated with the for­mula urinated smoothly. On the other hand, Kampo doctors today tend to use daiobotampito for difficulty of urination. We investigated the feature of daiobotampito in old medical textbooks, especially about “urination,” “gonorrhea,” and “intestinal abscess.” We searched old medical textbooks for daiobotampito, which were writ­ten or published before or during the Song Dynasty. In the textbooks other than ‘Jin Gui Yao Lue,' it is written that the patients urinated frequently. In the textbooks other than ‘Jin Gui Yao Lue' and ‘Ishimpo,' it is written that the patients sometimes urinated difficultly. In the old medical textbooks before or during the Song Dynasty, urination of the patients who should be treated with daiobotampito was smooth but sometimes difficult.

We report two cases of irritable bowel syndrome (IBS) with predominant constipation successfully treated with daijokito and then diagnosed as Alzheimer's dementia. [Case 1] An 82-year-old man. He had been treated for IBS with probiotic and purgative. However, the symptom of IBS did not get cured and he had suffered from digestive symptom with iracund mental condition. [Case 2] A 74-year-old man. He suffered from abdominal pain and constipation so he needed enema and stool extraction frequently. He sometimes angered if he could not get treatment without delay. In both cases, their bowel and mental condition improved after treatment with daijokito. After their conditions improved, we checked their cognitive function, and found the levels of their cognitive function were low. We diagnosed them as Alzheimer's dementia. The patients probably had felt the difficulty and gotten mental stress on usual days because of dementia, so the mental stress could complicate the symptoms of IBS. Daijokito probably improved the digestive symptom due to IBS and the mental stress from dementia of these patients, and after the treatment we could diagnose the dementia. Elderly patients with constipation and iracund mental condition might have dementia.

We have developed and operated a browser-based questionnaire system for Kampo medicine based on conventional questionnaires and review of systems to reveal implicit Kampo wisdom both in patients' questionnaire data and in some Kampo specialists' examination data. However, the questionnaire data were found to be inaccurate because too many questions were included and cumbersome input steps were required. The purpose of the present study was to solve these problems and to develop a new patient-centered questionnaire system with fewer questions and an easier input method. After analyzing inquiry database from collaborating institutes and hospitals, we deleted, combined, and added questions. We changed the evaluation method of symptoms from a visual analogue scale to a simple staged evaluation, and introduced another method to evaluate the main symptoms in each time of visit using a visual analogue scale. At the same time, a tool for predicting Kampo pattern diagnoses based on the questionnaire data was implemented. We have already started collecting more accurate and reliable data using the new questionnaire system. It is expected to support routine practices and facilitate more precise clinical research on Kampo medicine.

We report a case of a 39-year-old female who suffered from generalized anxiety disorder for 3 years after a spontaneous abortion and was successfully treated with kyukichoketsuin. She got generalized anxiety disorder and had difficulty to stay in a crowd after she had a spontaneous abortion at the age of 36. She visited our Kampo clinic because of the anxiety at her age of 39. We prescribed her yokukansankachimpihange for 6 months, but she still suffered from anxiety. After we changed yokukansankachimpihange to kyukichoketsuin, her anxiety improved. Kyukichoketsuin is a formula for various kinds of bad conditions during the postpartum period, which was described as the first therapeutic agent in “Manbyokaishun.” In this case, although the patient had suffered from mental disorder for three years after a spontaneous abortion, she showed a favorable response to kyukichoketsuin treatment. This result suggests that kyukichoketsuin may be effective for years of mental problems after parturition.

Kanzoshashinto consists of seven medicinal herbs including ginseng. The formula for kanzoshashinto in the Chinese medical text “Jinguiyaolue” consists of the seven herbs, but its formula in “Shanghanglun,” a second medical reference, lists only six herbs and does not include ginseng. We investigated if formulas for kanzoshashinto in traditional Chinese and Japanese medical books included ginseng. We searched modern Japanese databases using the terms kanzoshashinto and ginseng. We also searched medical books written during the Song Dynasty in China and the Edo period in Japan. We found one article in a modern Japanese database that discusses kanzoshashinto and ginseng. The article stated that kanzoshashinto formula included ginseng only described in the Song medical text Jinguiyaolue. Kanzoshashinto formula in other ancient Chinese medical references did not list ginseng as one of the components of the medicine. This research confirmed the statements written in ancient Chinese medical references : doctors could add ginseng to kanzoshashinto. During the Edo period in Japan, most doctors prescribed a kanzoshashinto formulation that included ginseng. In the medical reference “Jinguiyaolue,” kanzoshashinto with ginseng is described as a treatment for kowaku, an unstable psychological state. In the medical reference “Shanghanglun,” kanzoshashinto without ginseng was used to treat severe diarrhea. Therefore, it is possible that kanzoshashinto without ginseng might be a more effective treatment for diarrhea. Further studies are required to examine the efficacy of kanzoshashinto without ginseng in treating severe diarrhea.

Typically, Japanese Kampo doctors use formulas classified for treating blood stasis, to treat pain. However,there have been few reported cases where pain was treated with formulas classified for treating qi stagnation. Here, we report a case of right lateral epicondylitis in a 48-year-old woman who was treated with a focus on qi stagnation and with uyakujunkisan. She underwent conservative treatment at an orthopedic clinic for ten months, but her pain was not relieved. Hence, she opted for Kampo treatment. She was in a state of melancholy, felt heaviness throughout her body, and had irregular menstruation. These symptoms were mainly related to qi stagnation, and hence, we chose uyakujunkisan without white silkworm, but with aconite root. One month later, the stiffness in her shoulder improved and the pain was reduced. Magnetic resonance imaging taken 2 months later showed an improvement in the lesion. Nine months later, her menstruation became regular, and 11 months later, the pain had almost completely resolved and she could comfortably perform activities of daily living. Uyakujunkisan is introduced in the classical textbooks, and we interpret uyakujunkisan as a formula that can treat pain with qi stagnation. In Kampo treatment, effective pain treatment involves consideration of not only local blood stasis but also general qi stagnation.

We report the case of a 17-year-old male who had involuntary movements treated with yokukansankashakuyakukoboku. He had first recognized the involuntary movement 6 years previously. His symptom could not be alleviated with neurological and psychological treatments, and he visited our clinic for treatment with Kampo medicine. His symptom gradually alleviated with yokukansankashakuyakukoboku. The ancient physician Sekki (薛已) created yokukansan in China's Ming Dynasty. Yokukansan and its various add-on combinations were used in the Edo Era of Japan. Keisetsu Ohtsuka then created yokukansankashakuyakukoboku, which is however now rarely used because there is no extract drug in Japan. There are markedly nervous patients however, who can be treated with this formula. Thus, the authors feel that more research needs to be done on the differences between yokukansan and yokukansankashakuyakukoboku.

Physicians usually prescribe specific formulae which are classified as treating blood stasis for dysmenorrhea in Japanese Kampo medicine. Daisaikoto is not classified as the category and rarely used to treat dysmenorrhea. Here, we report 2 cases of dysmenorrhea that were successfully treated with daisaikoto. In case 1, the patient was a 19-year-old student. Menstrual pain worsened and accompanied premenstrual headache and vomiting, disturbing her to go college since she started her college life. Commercial non-steroidal anti-inflammatory drugs were not effective. Her Kampo abdominal findings included abdominal strength excessive, fukuman, kyokyokuman and tenderness in the peri-umbilical region. We diagnosed her as “excessive pattern”, “heat pattern”, “qi stasis”, and “blood stasis”. We prescribed extract of daisaikoto 7.5 g per day. Four weeks later, she reported improvement of premenstrual headache and vomiting. Twenty weeks later, she needed no more analgesics at menstrual period. In case 2, the patient was a 35-year-old mother. After entrance examinations of her son and moving, her menstrual pain, headache and irritability worsened. Her Kampo abdominal findings included abdominal strength slightly excessive, fukuman, kyokyokuman, shinka hiko, and tenderness in the peri-umbilical region. We diagnosed her as the same as case 1 and prescribed the same. Eight weeks later, she reported dissaperance of headache and irritability. Twenty weeks later, menstrual pain improved.

Here we report a case with fever, abdominal pain, frequent urination and urinary incontinence after vesicolysis, for bladder hematoma after transvaginal ultrasound-guided oocyte retrieval, that was successfully treated with Kampo medicine based on daily changing sho for acute disease.
A 44 year-old woman underwent transvaginal ultrasound-guided oocyte retrieval under venous anesthesia in the morning, in order to perform in vitro fertilization, and got home around noon. She had right lower quadrant abdominal pain, frequent urination, hemoptysis, urinary incontinence, fever and chill in that evening. Emergency room ultrasonography revealed a 45 mm size bladder hematoma. She was admitted and the vesicolysis was performed. Antibiotics and hemostatics were administered, and were followed by self-sustaining flow back into the bladder. Although she became afebrile on day 3, her right lower quadrant abdominal pain remained and fever returned on day 5. Daiobotanpito was prescribed because of the right lower quadrant abdominal pain, frequent urination, urinary incontinence, constipation and a floating pulse. Additionally, goreisan was prescribed because of her tooth mark and leg edema. On day 6, her abdominal pain had largely disappeared, and her frequent urination and urinary incontinence were also improved. However, perspiration with fever and soft stools then appeared. Keishito was prescribed because of the perspiration, a weak pulse and weak abdominal strength. Additionally choreito was prescribed for the frequent urination and urinary incontinence. She started sweating continuously with no fever. The frequent urination and urinary incontinence then also disappeared, and she was discharged on day 7.