he influential
Japanese publication Nikkei Medical carried out a detailed survey
in July 1998 to gauge the awareness and use of Kampo prescriptions among
medical professionals in university-affiliated hospitals in Japan. Questionnaires
were distributed to 2,000 clinical staff at university hospitals throughout
Japan. A total of 433 responses were received, yielding a 21.7% response
rate. Among the 430 valid responses, 318 (74.0%) indicated that they were
currently prescribing Kampo to their patients; 48 (11.2%) said that they
had prescribed Kampo in the past but were no longer doing so; and 64 (14.9%)
stated they were not prescribing Kampo or were unclear about the matter.
Data
about when respondents began prescribing Kampo drugs to their patients mirrors
the growth of the Kampo market, which increased from a total value of 33.7
billion yen in 1980 to 161.7 billion yen in 1990. The number of respondents
who began prescribing Kampo started to take off in 1976, when Kampo drugs
were first included in the national medical insurance reimbursement list,
reaching a peak around 1990. The expansion of the market, together with
advances in research on the efficacy and pharmacology of Kampo drugs, helped
create a favorable environment for the introduction of Kampo in institutions
with high standards like university hospitals.Based on responses to the survey, the chart below shows the conditions for which Kampo therapy was most frequently named the treatment of choice. The number of respondents citing the condition as well as the Kampo prescription(s) most commonly used to treat the condition are listed for each.
As can be seen, the two top-ranking conditions treated by Kampo prescriptions are menopausal symptoms and autonomic imbalance, and the respective prescriptions used to treat them are Toki-shakuyaku-san, Keishi-bukuryo-gan and Kami-shoyo-san. It is noteworthy that among hospital staff in the gynecological field, who frequently administer these drugs to patients with various complaints related to menopause or menstruation, 29 out of 30 respondents (or 96.7%) named Kampo drugs as the treatment of choice for these conditions.
The third-ranking condition for which Kampo treatment is the first choice is acute upper respiratory infection, and Kakkon-to and Sho-seiryu-to are widely prescribed for this condition. The mechanism of Kakkon-to, which is also the most widely used treatment for the common cold, was described in the previous issue of Kampo Today (Vol 3, No. 1). And Sho-seiryu-to, which is used to treat rhinitis associated with upper respiratory tract infections, has also been shown effective for allergic rhinitis in multi-location double-blind studies. (See Kampo Today, Vol 2, No.1.)
Other specialties where Kampo drugs were widely cited as treatment of choice were dermatology (named by 28 out of 32, or 87.5%); otolaryngology (24 of 29, or 82.8%); and internal medicine (93 of 122, or 76.2%). While 430 responses (out of 2,000 questionnaires distributed) is a limited sample, it shows in a concrete way the general areas and conditions for which Kampo is the preferred method of treatment in university hospitals, where Japan's most advanced medical treatment is provided.
| Condition: | No. of responses: | Kampo prescription used: |
| Menopausal symptoms, non-specific complaints | 70 | Toki-shakuyaku-san, Keishi-bukuryo-gan |
| Autonomic imbalance | 47 | Kami-shoyo-san |
| Colds, acute upper respiratory tract infections | 46 | Kakkon-to, Sho-seiryu-to |
| Chronic hepatitis | 41 | Sho-saiko-to |
| Fatigue, lack of energy | 38 | Hochu-ekki-to |
| Poor appetite | 28 | Rikkunshi-to |
| Constipation | 26 | Daio-kanzo-to |
| Dropsy | 26 | Gorei-san |
| Cramps and muscle pain | 24 | Shakuyaku-kanzo-to |
| Cough, phlegm | 20 | Bakumondo-to |