The Japan Society for Oriental Medicine (JSOM) has made various efforts against coronavirus disease (COVID-19) to build evidence. JSOM has launched an academic society-led clinical research project on COVID-19 based on the concept and characteristics of Kampo medicine, including (1) prevention of disease by activating the immune system to regulate body conditions (pre-symptomatic stage of illness), (2) symptom alleviation in the mild and moderate stage and prevention of aggravation (acute to subacute stage of illness), and (3) early recovery and improvement of prolonged symptoms (late stage of illness). Since the declaration of the pandemic, the special working group has conducted the following activities : enlightening academic members, lobbying other academic societies, preparing research protocols, establishing research groups, conducting ethical reviews, responding to the research disclosure system, preparing protocol papers and review articles as the basis for the research, reporting research progress, soliciting case reports, warning against Chinese medicine use, requesting for research support funding, and revising the JSOM website. We also discuss the interpretation of COVID-19 from the perspective of Kampo medicine and the direction of the selection of Kampo formulas in this report.

A commemorative lecture meeting on the inclusion of a new chapter of traditional medicine in ICD­-11 was held in Tokyo in February 2020. The head of the Collaborating Centre for WHO­-FIC in Japan explained the process of the project, which started in 2006 to increase WHO's data collection from developing countries and expressed gratitude to the concerned persons who made efforts to obtain consensus with China and Korea. WHO promoted integrated coding between traditional medicine and Western medicine. In the field of acu­puncture, meridian and collateral patterns proposed by Japan were adopted and research activities have begun. In the field of Kampo medicine, the prescription content is often used in a fixed form as a representative for­mula pattern in Japan, so clinically high­-level research will be possible under this new classification. In the field of medical information, it has been pointed out that there are high hurdles for medical information man­agers to understand traditional medicine. It is expected that the progress of mutual understanding of both medi­cines. From now on, activities in research, translation, education and dissemination of this new classification should be promoted.

According to the World Health Organization (WHO), mortality by age, sex, and cause of death is the foun­dation of public health both globally and domestically. Comparable mortality statistics over time and investi­gations of mortality were used to develop the International Statistical Classification of Diseases and Related Health Problems (ICD). In the ICD, the WHO states that morbidity statistics are also an essential foundation of public health, but they are much less widely applied. The 10th revision of the ICD (ICD-10) is now in use, but further revisions must be made in the development of the 11th revision (ICD-11) to capture advances in health science and medical practice, to make better use of the digital revolution, and to evaluate traditional medicine (TM). Revision of ICD-10 began in 2007, and an ICD-11 version for preparing implementation was released on July 18, 2018. ICD-11 features a new TM chapter on Japanese traditional medicine, known as Kampo medicine, traditional Chinese medicine, and Korean medicine. ICD-11 will be approved at the next World Health Assembly in May 2019 and will come into effect. This means that the WHO does not currently recognize the effects of TM, but that we as well as the WHO will have hard time to prepare and study the effects of TM on morbidity statistics. It is very important to the study of Kampo medicine that we will be able to properly evaluate the terms and classifications contained in ICD-11.

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.

Many of the students belonging to the School of Health and Social Services will be responsible for health education in the future, and it is important that they have an understanding of the importance of Kampo medicine and the ability to give appropriate guidance in the field. But their educational goals need discussing. We conducted lectures on Kampo medicine with medical school students towards this end, and conducted before and after questionnaire surveys to gauge their effect. Students with a desirable degree of awareness toward Kampo medicine in Japanese society increased from 58.0 ± 15.4% to 88.5 ± 10.2%, and students judging Kampo as either useful or extremely useful rose from 58.4% to 95.9%. It is our hope that, with the raised awareness from these lectures as a base, these students will go on to engage in suitable medical educational activities in the future.

In kampo medicine, an illness is considered to affect the entire body, even if the symptoms appear only in the abdomen. Abdominal palpation is considered an important diagnostic physical examination in kampo medicine. Because learning the kampo style of abdominal palpation is difficult, we attempted to simplify the process by developing typical models of 6 important kampo abdominal diagnoses (shinka-hiko, kyokyo-kuman, fukuchokukin-renkyu, shofuku-fujin, shofuku-koman, and shinkabu-shinsuion).1) When we discussed abdominal palpation in lectures on kampo medicine for clinicians we also assessed the opinions and impressions of participants about the abdominal palpation simulators. 2) We administered an anonymous questionnaire survey about interest in kampo medicine, the understanding of abdominal palpation in the kampo style, and an evaluation of the abdominal palpation simulators. We obtained 149 replies from participants of the 11 lectures. 3) Of the participating physicians, 85.2% were interested in kampo medicine. However, 23.5% of physicians were not familiar with abdominal palpation in the kampo style. 4) Furthermore, 58.4% of physicians thought that kampo-style abdominal palpation was explained well or very well in the lecture with the abdominal palpation simulators. The abdominal palpation simulators were judged to be useful or very useful by 72.2% of the physicians. 5) In conclusion, the abdominal palpation simulators were considered to be useful for learning abdominal palpation in the kampo style, even though these simulators have some shortcomings. These models may be useful for simplifying the learning of abdominal palpation by students of kampo medicine.

In Kampo medicine, sickness is regarded as affecting the whole body even though the symptoms may appear obvious only in the abdomen. This makes abdominal palpation an important means of physical examination, and diagnosis. Because learning abdominal palpation in the Kampo style is very difficult, we attempted to simplify learning by building typical anatomical abdomen models for training. To create six abdominal models : Shinka-hiko, Kyokyo-kuman, Fukuchokukin-renkyu, Shofuku-fujin, Shofuku-koman, and Shinkabu-sinsuion, we employed several materials, including artificial leather for epidermal tissue, pile fabric for subcutaneous tissue, cotton cloth or jersey cloth for membrane tissue, polyurethane or natural rubber for muscle tissue, specialized polyester resin for costae, and cotton for internal organs. We employed a harder polyurethane, for example, in Shinka-hiko to simulate resistance in the region beneath the heart, in Kyokyo-kuman to simulate resistance in the subcostal region, and in Shofuku-koman to simulate horseshoe-shaped resistance in the lower abdominal region. Otherwise, in Shofuku-fujin, a lack of resistance was simulated by a defect in the polyurethane at the center of the lower abdominal region. Shinkabu-sinsuion was modeled using a water dabbling sound via a water-filled balloon that could be gently shaken with the fist in the region above the navel. Fukuchokukin-renkyu was modeled as excessive strain of the rectus abdominis muscles via the use of natural rubber. We tried to represent the tenderness on pressure at the para-umbilical region, cecal region, and sigmoid region in the Shofuku-koman model by making a specialized switch with conducting rubber, and using electric device and battery. We believe these models are useful teaching devices, in that they simplify Kampo abdominal palpitation training.
Medicine, Kampo ; Cancer resistance to treatment ; Training ; Tissues ; Palpation

Hochu-ekki-to is one type of medicine that improves a Ki-deficiency. We therefore investigated the effects of Hochu-ekki-to on symptoms indicating a state of Ki-deficiency. In addition, we studied the effects of Hochu-ekki-to on blood pressure or body temperature. We studied 14 adult male patients with symptoms of general fatigue, lack of will power and appetite loss. We orally administered 7.5g of Hochu-ekki-to extract fine granules (EK-41) (Kanebo Pharm. Co, Tokyo, Japan) per day for four weeks. Before the oral administration of EK-41, and again four weeks later, we investigated any improvement of symptoms, and changes in the blood pressure or body temperature. After the oral administration of EK-41 for four weeks the general fatigue or lack of will power improved significantly (p<0.05), and we observed a significant increase in body temperature (p<0.05). The over all rate of “improvement” was 57.1%, and the rate for “slight improvement or more” was 71.4%. The oral administration of Hochu-ekki-to not only improved the symptoms of general fatigue and lack of will power but also raised the body temperature. This leads us to suspect that Hochu-ekki-to increased the metabolic function. We therefore consider the oral administration of Hochu-ekkito to be useful for the treatment of Ki-deficiency state patients with the symptoms of general fatigue and lack of will power.

Although the herbal preparation Kakkon-to is known to improve shoulder stiffness, there have been few studies attempting to elucidate the extent and mechanism of this effect. Kanebo Kakkon-to extract was administered orally to a group (n=19) of patients (pts) with shoulder stiffness (SS) at a dose of 2.5-7.5g/day, as well as to a group (n=9) of normal healthy subjects (NS). The effects and any side effects of Kakkon-to were then evaluated. The body surface temperature (BST) of the side of the neck was recorded from the Bide view position with a thermotracer before administration, after 30 minutes, after 60 minutes, after 90 minutes, and after 120 minutes. As for the general improvemant rates for this formula in the SS group, the rate of ‘remarkable improvement’ was 21.1%, ‘improvement’ 42.1%, and ‘slight improvement’ 15.8%. The overall utility rating, evaluated from the degree of improvement, was that the formula was considered ‘useful’ or better in 63.2% or the cases, and ‘slightly useful’ or better in 78.9% of the cases. Before administration of Kakkon-to, there was no significant difference between the BST of the SS group and that of the NS group, and no significant difference between the BST of improved pts in the SS group (n=12) and the BST of the Insufflciently improved pts in the SS group (n=7). The BST of the NS group 120 minutes after administration of Kakkon-to was higher than the pre-administration BST. There was no significant difference in the BST of the insufficiently improved pts of the SS group upon administration of Kakkon-to. The changes in the BST before and after administration of Kakkon-to were greater for the sufficiently improved SS group than for the insufficiently improved SS group or NS group. It was suspected that the effect of Kakkon-to on shoulder stiffness was due to improvement of blood circulation, as indicated by the higher BST.