We are planning a study focused on the gathering of clinical data for the purpose of formalizing diagnostic logic at 6 institutions specialized in Kampo-based medical examinations. However, during the planning stage, it has been recognized that there are a large number of Kampo formulas to be studied, and differences among faculties and individuals exist regarding how to identify each Kampo formula, methods of gathering findings, and the evaluation of efficacy. Here we report the solution proposal reached after building consensus among all participating faculties on these issues. After raising the issues, conferences were held for each of them, until a unanimous consensus was obtained. As a result, the following conclusions were reached. Thirty-three Kampo formulas were selected as targets for the formalization of diagnostic logic. In addition, the range of dosage forms, crude drug ingredients, and permissible dosages for each Kampo formula were determined. Regarding clinical findings for these Kampo medicines, the items to be collected and evaluation criteria were also established. The criteria for evaluating the validity and safety of each Kampo medicine were decided, together with the grading and timing of evaluation. We hope that our solution proposal reached after building consensus becomes the basis for Kampo research in the future.

We report two cases of inchinkoto treatment for obstructive jaundice via autoimmune pancreatitis (AIP). Case 1 : A 38-year-old male. After completion of treatment for Mikulicz disease, obstructive jaundice developed. A diagnosis of AIP was based on a high IgG 4 blood level and image views. T-Bil stayed above 20 mg/dl and there was no improvement by oral administration of prednisolone (PSL), ursodeoxycholic acid, or bilirubin adsorption therapy. Upon inchinkoto administration, T-Bil promptly fell to 3 mg/dL. Case 2 : A 77-year-old male. He suffered from itching and constipation, and blood data showed a pattern of obstructive jaundice. Image views suggested AIP, but a duodenal papillary biopsy could not provide a definitive diagnosis. Inchinkoto was administered, and the itching and constipation had mostly disappeared within 1 week. However, these symptoms recurred after one month. A definitive diagnosis of AIP was then reached based on a pancreas biopsy, and a PSL regimen was initiated. From these two cases, we consider that inchinkoto is useful for improving the symptoms of obstructive jaundice induced by AIP.

In Kampo medicine, a tongue examination, whereby the shape and color of the tongue is observed, is thought to reveal the constitution and condition of the patient. In Japan, numerous books on this tongue examination have been published. However, tongue findings are expressed differently in these books, and a standard description for such findings has yet to be established. A standard description would be useful when examining the tongue, and when educating students of Kampo medicine. We therefore compared how tongue colors and shapes were expressed in the Japanese literature on tongue examinations (12 publications).
Using these results, we have arrived at a standardized description for tongue findings in accordance with Kampo specialists of tongue diagnoses at many facilities. In the process, we focused on easily recognizable findings that can be noted with short clinical examination times, and that can also be understood by beginners.

Background: Globalization urges us to discuss rationale and policy towards establishing a medical education accrediting body in Japan. Experience of General Medical Council （GMC） suggests us some useful lessons.
Method: Based on our visits and investigation into in GMC, we inquire how Quality Assurance （QA） was introduced in UK with what incentives and how QA has brought reforms in the medical schools in UK.
Result: Since 2003, GMC has changed its policy for QA from ‘inspection’ to ‘dialogue’. Dialogical QA asks a medical school to think critically of their education and consider vigorous actions for further improvements.
Discussion: Implications from the experience of GMC are: 1.QA process in GMC makes medical schools take robust steps towards changes, 2. Sharing the rational and policy for QA created the solid base for its effective implementation, 3. There are possible difficulties in establishing structure to do an enormous amount of coordinating work, which is necessary for constructing ‘dialogue with medical schools’.

Background: In our hospital, a mini-lecture is given before a social gathering during “Cancer Salon-”
Purpose: To examine Significance of the mini-lecture.
Method: The results of a questionnaire survey of the participants were summarized.
Results: The mini-lectures were performed by multidisciplinary persons. The survey found that a significantly large number of the participants felt the mini-lectures by persons other than medical doctors were helpful (p=0.021).
Discussion: Mini-lectures are valuable in that they provide not only information but also “create an atmosphere” of the following meeting. In addition, to receive a favorable assessment from the audience, it is important for the speakers, even the doctors, to understand the feelings of the participants, and take part in the subsequent get-together without formality.
Conclusion: The mini-lecture creates an atmosphere toward the social gatherings, and leads the speakers to adapt to the occasion with the participants.

We experienced two cases of postherpetic neuralgia (PHN) improved with Kampo medicines that include uzu (i.e. uzu-zai).The pain from PHN was improved via the administration of an uzu-zai in these 2 cases, worsened by its discontinuation, and improved again by its re-introduction.Case 1 : A 76-year-old male suffering from PHN of the right L 2-3 area was administered uzukeishito and obtained pain reduction. After 12 months, his prescription was changed from uzukeishito to keishikaryoju-tsubuto. Then, after only 2 days his pain worsened again. Uzukeishito treatment was re-instated, and he again obtained pain reduction. Case 2 : An 82-year-old male suffering from PHN of the right C 4-5 area was given uzuto and obtained pain relief. After 3 months his prescription was changed from uzuto to keishikajutsubuto. Then, after only1week his pain worsened again. Uzuto was then re-introduced, and pain reduction was achieved again. These two cases led to two suggestions. First, that the uzu-zais were very effective against the PHN pain. Second, that this effect of an uzu-zai against PHN pain might be a symptomatic rather than a radical treatment.These two cases highlight the fact that the use of an uzu-zai was instrumental in reducing PHN-associated pain, but further studies will be needed to determine a dosage protocol, including when and at what pace uzu-zais might be reduced/discontinued.

We report two cases of numbness and pain of neuropathy due to ANCA (antineutrophil cytoplasmic antibody)-associated vasculitis successfully treated with Ogikeishigomotsuto. The first case was a 57-year-old female who complained of high fever, painful skin eruptions of the lower limbs, and proteinuria. Although the severe pain was reduced with steroid therapy, neuropathy-related numbness and pain remained widespread in her lower limbs. After we prescribed Ogikeishigomotsuto, most of her pain disappeared while her degree of numbness diminished by almost half in two weeks. In addition, her steroid therapy could be tapered off without adverse effect. The second case was an 82-year-old female with fever and myalgia. Although myalgia of the upper arm disappeared with steroid treatment, walking became difficult due to numbness from the lower legs, to the soles of her feet. With Ogikeishigomotsuto administration, she became better able to walk because her legs had warmed up, and the range of her numbness had decreased. These cases suggest that Ogikeishigomotsuto may be effective against numbness and neuropathic pain due to ANCA-associated vasculitis.
Numbness ; Pain ; Peripheral neuropathy ; Antineutrophil cytoplasmic antibody measurement ; Vasculitis

We report a case of an obstinate belch successfully treated with goshuyuto. The patient was a 74-year-old female. She had been hospitalized seven times in the past due to the belch, abdominal distention and anorexia, and had been prescribed various Kampo formulas. But her symptoms fluctuated up and down. The obstinate belch essentially disappeared after administering goshuyuto, and her appetite improved. Many of Kampo formulas that treat belchs are related to Shoyobyo (shao yang bing), but we consider that goshuyuto may be effective for a belch, which is yin-related and accompanied with stiffness and rigidity below the heart, and fullness in the chest and hypochondrium.
Medicine, Kampo ; Treated with ; Case Report ; plastic property - rigidity ; symptoms <1>

We report a case of recurring adhesive ileus that was successfully treated with shojokito (decoction) without inserting a nasogastric tube. The patient was a 75-year-old male who had been treated for abdominal symptoms in our department after a laparotomy. He visited our hospital mainly for complaints of abdominal pain and distention, was diagnosed with adhesive ileus because of a niveau image upon abdominal X-ray, and was hospitalized the same day. We diagnosed him as Yang syndrome and excess syndrome because he had thick yellow fur of the tongue, and administered shojokito. He broke wind at 40 minutes after administration of shojokito, and had bowel movement two hours later. Furthermore, he had mass diarrhea after another administration of this formula, and the niveau image disappeared the next day. It is often considered that an ileus develops with Cold, for which daikenchuto is prescribed frequently. However, in some cases cold purgative formulas such as jokito group may be effective, if such cases are Yang syndrome and excess syndrome, and present with yellow fur of the tongue.
Intestinal Obstruction ; Syndrome ; Treated with ; Yellow color ; Yang

Three cases of dermatosis successfully treated with modified Mao-rensho-shakushozu-to are reported. Case 1 was a 45-year-old male who had been suffering from atopic dermatitis since childhood. He came to our clinic for treatment with Kampo formulas for unchanging symptoms. At first we prescribed Mao-rensho-shakushozu-to-go-byakko-ka-keishi-to, but this formula was not effective. After prescribing Mao-rensho-shakushozu-to-go-eppi-ka-jutsu-to, the dermatitis improved. Case 2 was a 25-year-old male student who had been suffering from atopic dermatitis since he was 19 years old. He responded to steroid ointment, but relapsed frequently after the repeated reduction of steroids. Some Kampo formulas were not effective, but the dermatitis improved after the patient used Mao-rensho-shakushozu-to-go-eppi-ka jutsu-to. Case 3 was a 65-year-old male who had been suffering from psoriasis vulgaris since he was 57. Shakushozu-to-go-byakko-ka-ninjin-to was effective for his psoriasis.
We used modified Mao-rensho-shakushozu-to in the three cases described above be cause the patients had strong itching. It is possible to apply this Kampo formula for dermatitis with strong itching.