生薬と漢方臨床の接点を求めて

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タイトル別名
  • Seeking Contact Point for Crude Drugs and Clinical Application of Kampo Medicine.
  • ダイ53カイ ニホン トウヨウ イガクカイ ガクジュツ ソウカイ キョウイク コウエン ショウヤク ト カンポウ リンショウ ノ セッテン オ モトメテ

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A quarter century has passed since the implementation of the complete health insurance coverage of Kampo medicines in 1976. This drastic change has led to the wide use of this type of medications in the clinical setting. During this period, based on the myth “Kampo medicines have no adverse reaction” and the indoctrination “Kampo medicines are effective for various pathophysiological conditions that cannot be managed by Western medicine”, there was a transient, but dramatic increase in the use of Kampo medicines. It is certainly true that Kampo medicine has been beneficial in many patients. However, the expectation that Kampo medicines have been truly accepted by doctors who have properly managed their patients according to the principle of Western medicine is doubtful. This is partly because, based on the idea that it is firstly needed to make the use of Kampo formulations more easy in the hands of clinicians, Kampo medicines have been dealt with as if they were single components although they are actually complex entities. Due to such misunderstanding, prescribing physicians have lost their interest toward the contents (component crude drugs) of Kampo medicines. Numbered extracts are certainly convenient for clinicians who use Kampo medicines according to the concept of Westem medicine. Let me introduce Mashinin-gan (No. 126) as an example. Unfortunately, doctors use this Kampo medicine just to improve bowel movement. I think that we can understand the true worth of Joki-to formulae, which used to play an active role in the treatment of yang ming bing, a condition once thought as refractory, only if we recognize that Mashinin-gan is a modified formulation of Sho-joki-to (immature orange, magnolia bank, Rhubarb Rhizome) and then pursue its use differentiating from Juncho-to (No. 51), Dai-joki-to (No. 133) and Tsu-do-san (No. 105). Upon such consideration, we understand that to learn the principle of Shang han lun [a treatise on Shang han (a form of an acute infectious disease)] is to place importance on the Chinese classic. I think that, in the past, at the meetings of the Japan Society for Oriental Medicine, more attention was paid to the origin of crude drugs as well as the efficacy of Kampo formulations. “What is the origin of Rhubarb Rhizome you used?” or “Is bupleurum root you mentioned Bupleurum falcatum Willd or Bupleurum falcatum Linné?” Of course, we must not stick to this aspect too much, but we will have trouble if we pay absolutely no consideration to the components of Kampo medicines we actually use, even when we use extracts. This is an era of evidence-based medicine (EBM). When we clinicians treat patients with Kampo medicines that cannot be characterized by single chemical formulae, we can value their clinical efficacy only if we stick to the quality of crude drugs to the extent possible. The man subject of this meeting is “To Get Handfuls of Blessings of Great Nature.” At this meeting, I would like to describe the current clinical application of Kampo medicines and actual efforts made by farmers who engage in the cultivation and gathering of well-known crude drugs. I hope that my lecture will help to make clinicians aware of the characteristics of each crude drug for the clinical application of Kampo medicines.

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