As the 21^st century advances, evidence-based medicine (EBM) has come to be regarded as essential in all field of medical sciences and practical medicine. Creating medicines have been searching for based on EBM and development of new medicine has been carried out.In Japan the number of diabetic patients has increased to 129% during recent 10 years. The number of diabetic complications has also increased and hemodyalysis has been introduced in approximately 16,000 patients/year with diabetic nephropathy in Japan in 2008.Additinally many diabetic patients are suffering from numbness, cold sensation and pains in extremities derived from diabetic neuropathy. Therefore reduction of diabetic complications is one of the most important considerations in the field of diabetic patient care.Diabetes mellitus is equivalent to wasting-thirst in Jomgiiyaolue.We have reported the effectiveness of Goshajinkigan (GJG) for the treatment of nembness associated with diabetic neuropathy for the first time in Japan in 1984.In controlled comparative study, GJG showed significantly higher rates of improvement of this symptom versus mechobalamin.Insulin resistance has an important role on the occurrence of type 2 diabetes and metabolic syndrome.We have studies the effects of Kampo medicine on the insulin resistance using the euglycemic clamp and molecular biological techniques.1) Animal experimental studies: The improvement of insulin resistance in STZ rats by the administration of GJG might be via NO pathway and due, at least in part, to correct in the abnormal early steps of insulin signaling pathway in skeletal muscle.2) Clinical Studies: Effects of GJG on insulin resistance in patients with type 2 diabetes were investigated. HOMA-R was significantly decreased after GJG treatment (P=0.019). On the other hand, HOMA-R in the control group did not show significant difference. HOMA-R returned to the pre GJG treatment level1month after GJG discontinuation (P=0.018). The high-dose clamp resulted in a significantly increased insulin action (MCR levels) after GJG treatment.These animal experimental and clinical studies suggest that GJG might be effective for improving insulin resistance in the patients with type 2 diabetes.Kampo formulations might be useful not only for the prevention and the treatment of diabetic complications but also effective for the prevention and treatment of type 2 diabetes.In conclusion GJG has been used for the treatment of numbness and dysnuria since the statement in Yanshijishengfang. We have found the effectiveness of GJG on the treatment of diabetic neuropathy and on the prevention and the treatment of type 2 diabetes. We would like to continue these scientific activities.

OBJECTIVESThis study investigated the incidence of caries in infants and explored the risk factors related to noteworthy variations between urban and rural areas.

METHODSSubjects were 232 infants (111 males and 121 females) aged 1.6 and 3 years born in "N" town between the fiscal years of 1997 and 2001. Infants aged 1.6 and 3 years had 99.6 and 100% participation in health checkups, respectively. Of the total, 148 and 84 infants were living in the urban and rural areas, respectively, of "N" town.

RESULTSCaries incidence and the average number of carious teeth (decayed/missing/filled teeth, dmft) for infants aged 1.6 years were significantly higher in the rural area than in the urban area, indicating that environmental factors that predispose infants to develop dental caries exist in the rural area. In addition, logistic regression analysis for infants in each of the two areas revealed that risk factors of the child-care environment, for example living with grandparents and brushing by parents, stood in marked contrast with each other. Moreover, the odds ratio of the risk factor dozing off while drinking showed a marked difference between the areas, although this risk factor was common in both areas.

CONCLUSIONSThe results of this study indicated that several factors of the child-care environment, for example the daytime caring person, are related with caries development. Scientific elucidation of the risk factors that give rise to high prevalence of caries in specific regions and access to the whole picture of the disease mechanism may have great potential to lead to the development of effective countermeasures and to contribute to the reduction of dental caries in preschool children.

Metabolic syndrome develops because of an accumulation of intra-abdominal fat. In Kampo medicine, an abdominal examination is commonly performed for the diagnosis of diseases. Thus, we examined the relationship between metabolic syndrome and abdominal tension. Our subjects were 999 people (619 males and 380 females) who underwent regular physical check-ups. Metabolic syndrome was diagnosed in 14.5% (21.3% of males and 3.4% of females) and the prevalence rate of subjects with metabolic and pre-metabolic syndromes was 40.8% (55.9% of males and 16.3% of females). In addition, abdominal examinations detected 19.1% of hyperfunction, 64.6% of intermediate function, and 16.3% of hypofunction. Almost subjects with abdominal hyperfunction were classified as metabolic or pre-metabolic syndrome, and neither metabolic nor pre-metabolic syndrome was present in subjects with abdominal hypofunction. In conclusion, assessment of abdominal tension may become an additional valuable screening method for metabolic syndrome.
Syndrome ; Metabolic syndrome ; hypofunction ; hyperfunction ; Abdominal

Medicine, Kampo ; Metabolic ; Therapeutic procedure ; Syndrome

Scientific elucidation of “oketsu (blood stasis)” states is very important to understanding the diagnostic methods of oriental medicine. We investigated the correlation of blood fluidity to oketsu states, by micro channel array flow analyzer (MC-FAN). Twenty-seven female patients were divided into three groups: a non-oketsu group, a mildly affected group, and a severely affected group according to the diagnostic criteria of their oketsu syndrome. Immediately after collecting their venous blood, whole blood passage time was measured by MC-FAN. And we compared and investigated the correlation with degree of oketsu state, diagnostic criteria and changes of whole blood passage time after the administration of ku-oketsu drugs. As a result, whole-blood passage time of the mildly affected group and the severely affected group were significantly longer than that of the non-oketsu group, while the [an] improvement of blood fluidity was observed after medication. This study confirms that reduced blood fluidity is seen using MC-FAN in oketsu states, and that ku-oketsu drugs are able to improve these states.

Recently in Japan, the numbers of diabetic patients have been increased to 7.4 million and to 16.2 millions if the subjects of impaired glucose tolerance are added. Most Japanese diabetic patients are type 2 (non-insulin dependent). Decreased secretion of insulin and insulin resistance play important roles on the occurrence and progression of type 2 diabetes.
Long-established systems of traditional medicine have evolved from systematic recordings of human evidence for more than 3 thousands years. In addition the traditional Chinese medicinal philosophy is one of the oldest medical sciences in the world and has a long-standing history in the usage of herbal medicinals. Nowadays the use of complementary/alternative medicine and especially the consumption of botanicals has been increasing rapidly worldwide.
1. Clinical Studies
The management of diabetic neuropathy is one of the most difficult clinical problems. Among 65 patients with diabetic neuropathy who suffered from numbness of lower extremities 43 (66.2%) experienced some degree of improvement after oral administration of Goshajinkigan (GJG). Following our first report, more than 10 papers were published in Japan and almost same results were obtained. In a well-controlled comparative study, the efficacy of GJG and mecobalamin in diabetic neuropathy was estimated. After oral administration of GJG, the general improvement rate was 80.0%, while it was 48.1% in mecobalamin. The difference between the two groups was statistically significant (P<0.01). These results suggested that GJG is a useful medicine for amelioration of numbness due to diabetic neuropathy.
2. Animal experimental studies
Regular physical training has been known to be beneficial in the prevention and the treatment of life-style related diseases such as type 2 diabetes. However, it is very difficult for diabetic patients to continue physical exercise training for a long time. Troglitazone has insulin-sensitizing actions but it withdrew because of severe fatal hepato-toxic actions. Therefore development of insulin-sensitizing medicine without significant side-effects have been expected.
Chinese herbal medicine has less frequent side effects when compared to modern western medicine.
In the present study, the effect of GJG on insulin resistance in streptozotocin (STZ, 50mg kg^-1 BW, ivy.)-induced diabetic rats was examined by means of the euglycemic clamp procedure.
The improvement of impaired insulin action in STZ-diabetic rats by single and repeated administration of GJG may be due, at least in part, to enhance insulin signaling, and subsequent ameliorated production of NO. In conclusion,
(1) Diagnosis and primary treatment to reduce blood glucose including diet, exercise, oral hypoglycemic agents and insulin should be practiced by western style medical sciences. (2) Kampo medication is useful for the prevention and treatment of diabetic complications. (3) Kampo medicine has the possibility of prevention of type 2 diabetes.

OBJECTIVETo investigate the relationship of cumulative fatigue symptoms among caregivers in Japan with work environment issues and lifestyle behaviors.

METHODSThe subjects were 376 women (mean age, 54 years) attending professional seminars for caregivers held between 1999 and 2002. After obtaining informed consent, a survey was conducted to ascertain work environment issues, lifestyle behaviors and fatigue levels. Fatigue was quantitatively assessed using the Cumulative Fatigue Symptoms Index (CFSI) developed by Kosugoh et al. Factors related to caregiver fatigue were identified using Pearson's correlation coefficient, the Mann-Whitney U-test and multiple regression analysis.

RESULTSCaregivers who felt an xiety or concern regarding care techniques, care content, personal relationships, work conditions, and physical fitness showed higher CFSI scores, while caregivers who exercised regularly and had proper eating behavior displayed lower CFSI scores. Anxiety/concern regarding physical fitness and proper eating behaviors were identified as significant predictors for all CFSI category scores (P<0.001). Regular exercise behavior (P<0.001), age (P<0.001), and years of work experience (P<0.001) also represented significant independent variables for some CFSI categories.

CONCLUSIONOur results suggest that upgrading the knowledge and skills of care and nursing and modifying lifestyle behaviors could reduce the level of fatigue experienced by caregivers.

OBJECTIVESTo evaluate the physical strength, cerebral function, and mental health conditions in elderly persons, and to examine the correlation between these functions.

METHODSThe subjects were 151 independent-living elderly Japanese women, mean age 70 +/-5 years (+/-SD; range, 60 to 80 years), with normal abilities in daily life. The health check-up was conducted from April to May 1997. Physical strength was estimated by measuring seven activities. Cerebral functions were assessed by six sub-tests of the General Aptitude Test Battery (GATB). Their mental health status was measured by four sub-scales of the General Health Questionnaire (GHQ)-28.

RESULTSThe physical strenght and almost all of the cerebral functions decreased with age. Social dysfunction and severe depression on the GHQ sub-scales also worsened with age. Physical strength was strongly correlated with cerebral functions after adjusting for the confounding effect of aging. There were also interrelations between physical strength and mental health.

CONCLUSIONSThis study provided important information on the correlation between physical and mental status in elderly women. Future longitudinal studies with the intervention of physical training are required to determine whether a causal relationship exists between these factors.

The effect of daily walking on body fat distribution was investigated using an electronic pedometer and ultrasonography. Subjects were 77 women, aged 31 to 72 years. They were divided into four groups according to the average number of steps they walked per day(I<7, 500, 7, 500≤II<10, 000, 10, 000≤III<12, 500, 12, 500≤IV). Subcutaneous fat in the trunk and limbs, and the minimum thickness of subcutaneous fat(Smin) and the maximum thickness of preperitoneal fat(Pmax) below the xiphoid process were measured by ultrasonography. Abdominal wall fat index (AFI) reflecting the intra−abdominal fat accumulation was obtained by dividing Pmax by Smin. Fat distribution was analyzed by ANCOVA, controlled for age, body mass index(BMI), percent body fat, and menopausal status. Energy and macronutrient intake were obtained through a nutritional survey. There were no significant differences in anthropometric variables, energy and macronutrient intake, and subcutaneous fat thickness in trunk and limbs. Pmax of Group I was significantly higher than Group IV. Furthermore. Group I showed significantly higher AFI than the other three Groups (II, III, IV). The results of this study suggested that women who walked less than 7, 500 steps per day tend to have significantly increased intra−abdominal fat accumulation.
Fatty acid glycerol esters ; Group I ; Walking ; Roman Numeral IV ; Amniotic Fluid Index

From the viewpoint of atherosclerosis prevention, it is important to examine the effects of exercise on the lipoprotein fraction in the postprandial state. The purpose of this study was to investigate the effects of a single period of low-intensity exercise on serum lipoprotein triacylglycerol (TG) after an oral fat load (50g/body surface area) as exogenous TG. Seven normolipidemic men aged 23.1±1.1 years (mean ± SEM) took part in two trials. The subjects were all young students at a university graduate school. In the exercise trial (Ex), they exercised for 1.5 h on a bicycle ergometer at 35-40% of their maximal oxygen uptake, starting 2 h after ingestion of the fat, and then rested for a further 2 h. In the control trial (Co), they rested for 5.5 h after ingestion of the fat. Lipoprotein and lipid levels were measured in venous blood taken during the fasted state and at different intervals between the two trials for 5.5 h after the fat load. Serum total TG and high-density lipoprotein (HDL) TG decreased significantly in Ex from 3.5 to 5.5h (p<0.05, p<0.01) in comparison with Co. These results indicate that a single period of low-intensity exercise reduces exogenous serum total TG and HDL-TG.