Growing evidences indicate that the development of mesenteric phlebosclerosis (MP) is associated with long-­term gardenia fruit (GF) intake. Besides duration and total dosage of GF ingestion, other factors associated with the development of MP or the symptoms of MP have not been known. We searched for previous case reports of MP from Japan. MP patients were divided into two groups : asymptomatic group without abdominal symptoms or symptomatic group. Age, gender ratio, body size, and duration of GF ingestion of the both groups were statistically analyzed. We evaluated concomitant diseases that can cause elevated venous pressure in the both groups. Colectomy rate were compared between symptomatic men and symptomatic women. Severe symptoms including ileus, stenosis peritonitis, and perforation were also compared between men and women. Age and sex were analyzed in all 164 cases. The gender ratio of women to men in the symptomatic group was higher than that in the asymptomatic group. However, colectomy rate in the symptomatic group was similar between men and women. Ileus, stenosis, peritonitis, and perforation were similarly found in both men and women. We found 15 symptomatic MP patients with concomitant diseases that can cause phlebostasis. None of the asymptomatic had these diseases. Concomitant diseases that can cause elevated venous pressure might be associated with symptomatic MP. The severity of MP seems to be similar between men and women. Association of gender difference with the development of MP symptoms was uncertain.

It is theoretically thought that Paeoniae Radix (shakuyaku) has a sour taste and astringent action in traditional Chinese medicine. To examine the practical taste of shakuyaku, 12 volunteers sampled the decoction of Paeoniae Radix Rubra (sekishaku) and Paeoniae Radix Alba (byakushaku). Each volunteer determined how sekishaku and byakushaku taste among “five tastes” : sweet, salty, bitter, sour, or spicy. Most volunteers chose bitter taste and none of them chose sour taste as the foremost taste of shakuyaku. At least in the modern age, shakuyaku may have little sour taste. In this article we discussed the astringent action and the muscle relaxant action of shakuyaku with reference to the sour taste.

Berberine-containing goldenseal root has been classified into Group 2B (possibly carcinogenic to humans) by International Agency for Research on Cancer based on evidence of carcinogenicity in experimental animals. It was also confirmed that ultrahigh concentration berberine can induce DNA damage in cultured cells. Thus, two articles in Journal of Japan Medical Association advocated carcinogenicity and reproductive toxicity of oren, obaku, and daio considering that ingredients of daio and berberine contained in oren and obaku can cause DNA damage. However, many fallacies and arbitrary descriptions are observed in the two articles. The concentration of berberine that caused toxicity in the experiments is extremely higher than the possible concentration in humans taking Kampo medicine. Although no studies have shown carcinogenicity and reproductive toxicity of oren or obaku, the advocates in the articles were played up by a weekly magazine causing unreasonable anxiety to patients. Here, we present scientific counterarguments against the fallacies of the articles.

A thirty-eight-year old woman with facial pain was diagnosed with trigeminal neuralgia, and treated with conventional carbamazepine therapy. Although the pain was alleviated to a certain degree, she visited our clinic to receive Kampo therapy. Judging from her facial injury in an accident thirty years ago, jidabokuippo was administered in addition to carbamazepine. The trigeminal neuralgia was then relieved, and Takagi's tender point in her abdomen was also reduced or disappeared. She could finally stop carbamazepine therapy. This case suggests that neuralgia patients with previous injury and Takagi's tender point can be treated with jidabokuippo.

To estimate the incidence of liver injury related to Kampo medicine containing Scutellaria baicalensis, all medical records in our clinic were retrospectively examined. Among 2,430 patients who took Kampo medicine containing Scutellaria baicalensis, liver blood tests were performed in 1,547 cases (63.7%). The possibility of liver injury related to Kampo medicine containing Scutellaria baicalensis could not be denied in 19 cases (1.2%) among the 1,547 cases. The clinical features of liver injury in 19 cases were not different from those in previous reports. In agreement with the previous literature, this study also suggests that the incidence of liver injury related to Kampo medicine containing Scutellaria baicalensis is about 1%.

Recently, basophil activation test (BAT) has been applied to the diagnosis of drug allergy. We performed BAT for various Kampo medicines taken by 12 cooperators to evaluate the concentration which arouse nonspecific reaction during incubation in BAT. When whole blood of each was incubated for 24 hours with each Kampo medicine, false positive results were frequently observed. After 1-hour incubation with Kampo medicine at high concentration (1/312.5), false positive results were sometimes observed. These results suggest that in the diagnosis of Kampo-medicine adverse reactions, BAT should be performed in the condition of 1-hour incubation with lower concentration (1/1250 or lower).

A 47-year-old woman visited our clinic, and thereafter she had taken various Kampo medicines until she turned 58 years old. She took each medicine, containing 1-3.5 g/day of glycyrrhiza, for one or two months. Hypertension or edema was not observed in those days. From the age of 60, she took 7.5 g of tokishigyakukagoshuyushokyoto, containing 2 g of glycyrrhiza, day after day. Hypertension or edema was not observed for 35 months. However, when she was 63 years old, pseudoaldosteronism with headache, hypertension, edema,and hypopotassemia was observed for the first time. This case suggests that administration period or patient's age influences the development of pseudoaldosteronism.

Incidence of glycyrrhiza-induced pseudoaldosteronism is not well understood. We examined relationships between pseudoaldosteronism incidence and daily glycyrrhiza dose in previous clinical studies. The incidence in patients administered glycyrrhiza 1 g/day was 1.0% (mean). The incidence with 2 g/day, 4 g/day and 6 g/day were 1.7% (mean), 3.3% and 11.1% (mean), respectively. Thus a dose-dependent trend toward pseudoaldosteronism incidence was suggested by previous literature.

To diagnose liver injury related to Kampo medicine accurately is not easy. Lymphocyte transformation tests are likely to give a false positive for Kampo medicine. Diagnostic criteria with a scoring system provide low specificity for the diagnosis of Kampo-related liver injury. This article intends to outline the problems with diagnosing Kampo-induced hepatic injury, and to review previous studies to shed light on its incidence and clinical features. Kampo-related liver injury incidence was 0.1% or less, and that related to Scutellariae Radix was 0.5-1.0% in the literature. The symptoms, types, and recovery periods were similar to those for western drug-related liver injuries.

We consecutively enrolled all patients who visited our Kampo clinic from October 2004 to September 2008, and examined whether or not milk drinking causes abdominal fullness, pain or diarrhea in the patients. Among 3,175 patients enrolled, 35 patients (1.1%) complained of symptoms of milk intolerance. Granulated Kampo extracts containing lactose were administered to 20 patients among the 35 patients, but these Kampo extracts did not cause symptoms of lactose intolerance in 13 patients among the 20 patients. The true incidence of lactose intolerance caused by granulated Kampo extracts may be smaller than 1% at most.