Improving the Quality of Postgraduate Education in Traditional Japanese Kampo Medicine for Junior Residents: An Exploratory Survey Conducted in Five Institutions in the Tohoku Area.

Traditional Japanese (Kampo) medicine has been widely applied in general medicine in Japan. In 2001, the model core curriculum for Japanese medical education was revised to include Kampo medicine. Since 2007, all 80 Japanese medical schools have incorporated it within their programs. However, postgraduate training or instruction of Kampo medicine has not been recognized as a goal for the clinical training of junior residents by Japan's Ministry of Health, Labour and Welfare; little is known about postgraduate Kampo medicine education. This exploratory study investigated attitudes about Kampo medicine among junior residents in Japanese postgraduate training programs. A questionnaire survey was administered to junior residents at five institutions in the Tohoku area of Japan. Questions evaluated residents' experiences of prescribing Kampo medicines and their expectations for postgraduate Kampo education and training. As a result, 121 residents responded (response rate = 74%). About 96% of participants had previously received Kampo medicine education at their pre-graduate medical schools and 64% had prescribed Kampo medications. Specifically, daikenchuto was prescribed to prevent ileus and constipation after abdominal surgery and yokukansan was prescribed to treat delirium in the elderly. Residents received on-the-job instruction by attending doctors. Over 70% of participants indicated that there was a need for postgraduate Kampo medicine education opportunities and expected lectures and instruction on how to use it to treat common diseases. In conclusion, we have revealed that junior residents require Kampo medicine education in Japanese postgraduate training programs. The programs for comprehensive pre-graduate and postgraduate Kampo education are expected.

[How to Teach Kampo Medicine in the Age of Internationalization?].

Given the universal prevalence of complementary and alternative medicines, as well as integrative medicine, the usage of traditional medicine has been gaining in popularity worldwide. Japanese Kampo medicine and traditional Chinese medicine (TCM) are both derived from ancient medicines used in East Asia in the 5th-7th centuries, and have developed independently since the 14th century. Now Kampo medicine and TCM have different theories for the diagnosis and use of crude drugs. Unfortunately, Kampo medicine is not well known in Europe and the Americas; as a matter of practice, TCM is the international standard for traditional medicines derived from ancient East Asia. In the teaching of Kampo medicines to undergraduate students in a school of pharmacy, the author considers that a minimum requirement is to explain the differences between TCM and Kampo medicine. For graduate students of pharmaceutical science, the students must know the distinct medical theories of both TCM and Kampo medicine, and furthermore, must be able to read and write articles in English about traditional medicines, in order to help put Kampo medicine on the world map.

Regulation of traditional herbal medicinal products in Japan.

Kampo medicines are the main traditional herbal medicines in Japan and are classified as pharmaceuticals. They are based on ancient Chinese medicine and have evolved to the Japanese original style over a long period of time. Ethical Kampo formulations are prescribed in general practice by physician under the National Health Insurance reimbursement system. Over-the-counter (OTC) Kampo formulations can be purchased and used for self-medication in primary health care settings. Kampo medicines have a substantial role in the Japanese healthcare system. In the early 1970s, "The Internal Assignments on the Review for Approval of OTC Kampo Products", known as "210 OTC Kampo Formulae", was published by the Ministry of Health and Welfare (currently the Ministry of Health, Labour and Welfare). In 2008, "210 OTC Kampo Formulae" was revised and presented as "The Approval Standards for OTC Kampo Products" and now 294 Kampo formulae are listed in the standards. These products have had wide spread usage in Japan. Crude drugs and Kampo extracts have been listed in The Japanese Pharmacopoeia. Both The Approval Standards and The Quality Standards play a key role in regulation of Kampo products. "Application Guideline for Western Traditional Herbal Medicines as OTC Drugs" was published in 2007. Other ethnopharmaceuticals mostly from Europe could be approved as OTC drugs in Japan.

Evidence-based research on traditional Japanese medicine, Kampo, in treatment of gastrointestinal cancer in Japan.

Gastrointestinal cancer is a great threat to human health in Japan. Conventional anticancer therapies including surgery, radiation, and chemotherapy are the main strategies and play important roles in curing this disease or extending the life of patients with these cancers. On the other hand, patients undergo great suffering induced by these treatments. Kampo, the Japanese traditional medicine, has been used in clinics to reduce side effects and to improve the quality of life of gastrointestinal cancer patients in Japan. In order to testify to the efficacy and safety of these Kampo medicines and to clarify the underlying mechanisms, a number of clinical and basic studies were implemented in the past several decades. These studies suggested the benefits of Kampo medicine as an adjuvant to conventional anti-cancer therapies in treating gastrointestinal cancer. Since the safety and efficacy as well as quality control of traditional medicine have long been focused worldwide, the development course of Kampo medicine may provide reference to other countries in the world.

Clustering analysis of keishibukuryogan formulas by use of self-organizing maps.

Kampo medicines, traditional herbal medicines in Japan, are comprised of multiple botanical raw materials that contain a number of pharmacologically active substances. Conventionally, the quality control of kampo medicines has been performed by analyzing the contents of two or three representative components. However, it is not sufficient to check quality only with a limited number of specific components. We performed HPLC of 287 lots of keishibukuryogan formulas, calculated the areas of 11 components on chromatograms as feature values and made a cluster analysis using self-organizing maps (SOMs). We verified the precision (repeatability and intermediate precision) of clustering results when using the same samples and successfully established an clustering method using SOMs that is capable of precisely clustering differences in HPLC-fingerprints among pharmaceutical manufacturers, differences in HPLC-fingerprints due to the combination ratios of botanical raw materials, and differences in HPLC-fingerprints due to changes in component contents caused by time-course deterioration. Consequently, we could confirm that this method is useful for controlling the quality of multiple component drugs and analyzing quality differences.